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Doctors fail patients with acute kidney injury

Report slams clinical care of emergency kidney patients

OnMedica Staff

Thursday, 11 June 2009

Doctors are failing emergency kidney patients, according to a report issued today.

The National Confidential Enquiry into Patient Outcome and Death looked at 564 patients who died in hospitals in England and Wales from acute kidney injury (AKI) and concluded that half of the patients did not receive a good standard of care.

And it was doctors who were to blame.

"Deficiencies in AKI care are primarily related to the clinicians managing those patients and not deficiencies in process or material," stated the report, "This may indicate a lack of awareness of the inherent risk of AKI amongst hospitalised patients; a poor understanding of the pathophysiology of the condition; or inadequate knowledge of its management amongst medical staff."

The report further suggested that this reflected deficiencies in training both at undergraduate and postgraduate level.

The NCEPOD report judged that there had been unacceptable delays in recognising post-admission AKI in 43% of patients, despite the fact that a fifth of post-admission AKI was both "predictable and avoidable". Complications were found to have been missed in 13% of cases and managed badly in 22%.

Some 33% of patients had inadequate investigations, although these omissions were "basic clinical examinations and simple laboratory tests" and recognition of acute illness, hypovolaemia and sepsis was described as "poor".

The NCEPOD made a number of key recommendations, including the fact that all acute admissions should receive risk assessment for AKI and that patients should be reviewed by a consultant within 12 hours of admission.

Health Minister Ann Keen said she was seriously concerned that some hospitals were failing to follow the National Institute for Health and Clinical Excellence's requirements on kidney care.

"In 2008, we established NHS Kidney Care to drive service improvement locally and will work with the team to support the NHS in ensuring that patients with acute kidney injury get the best possible care," she said.

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